Pumping is a link to a new life, but IN MY OPINION, it requires a lot of self-education for it to be a relatively smooth transition. With this in mind, I have written a little 'Self Awareness Quiz'. If you know the answers to ALL the questions, I would suggest that you are well on your way to a positive experience. With support from an educated pumping team, you can't lose!
Knowing ALL the answers is *NOT NECESSARY* before you start pumping, or put your child on the pump. I want to stress that this is an *awareness* quiz and I have put it together for information purposes only. Consider it a way to gauge your degree of preparedness and use it, if you like,to determine where you require more education. I look at it as a Defensive Driving course for Pumpers.
If you are already pumping, you might use it as a refresher :)
***When pumping insulin, people will react differently to the same *thing*. What works for you, may not necessarily work for someone else and vice versa.
PUMPING AWARENESS SELF-QUIZ
This 'quiz' has been designed to raise your awareness of things you should know about pumping. The more you know, the easier the transition will be. If you feel you need more information about a particular topic, the answers to all the awareness questions can be found in the book 'Pumping Insulin' (John Walsh/Ruth Roberts) and on the "Insulin Pumpers Website" (http://www.insulin-pumpers.org). Your Diabetes team is an important part of pumping successfully, draw on their knowledge and support as well.
1. Have you read the book 'Pumping Insulin' by John Walsh, and Ruth Roberts? If you have, it will make things a lot easier for you :)
2. Describe a basal rate. How does it differ from a carbohydrate bolus?
3. Describe a bolus ratio. How does a carbohydrate bolus differ from a basal dose?
4. What is a Fasting Basal Check and why do you do it?
5. How do you set and test basal rates?
6. How do you set and test carbohydrate bolus ratios.
7. What would make you suspicious that it is time for a basal rate change?
8. What would make you suspicious that it is time for a carb bolus ratio change?
9. Do you understand Carbohydrate Counting?
10. How would you treat a high blood glucose? Would your methods change depending on the severity of the high blood sugar?
11. How many grams of simple carbohydrate would you use to treat a low, without overtreating? How would you determine this?
12. Do you understand the Unused Insulin Rule?
13. Have you read the user manual inside out and upside down?
14. Do you know of all the infusion sets available to you?
15. Where can infusion sets be inserted?
16. When do you need to check your Blood Glucose?
17. Do you have a chart for recording Carbohydrates, Boluses, Basal Rates, and Blood glucose readings?
Answers/Information below..BUT DON'T PEEK YET!!
....you peeked...didn't you :)
1. We use the book 'Pumping Insulin' (John Walsh and Ruth Roberts) as our bible. The information in this book is fantastic and will make your life much easier. The 'Insulin Pumpers' website is a tremendous help if you are able to access the web. While the book Pumping Insulin is our bible, the Insulin Pumpers Website is our daily prayer :) We would not have been as successful without its information and the support/advice of its members. Your diabetic team is a wealth of information and support for you and you should be discussing your methods with them and drawing on their knowledge.
2.Basal rate. The basal rate on your pump determines the amount of insulin you will receive hourly/daily to cover your body's need for insulin while NOT eating. It differs from a carbohydrate bolus in that it covers the body's BACKGROUND insulin requirements and is received over a 24 hour period. SETTING PROPER BASALS IS THE MOST IMPORTANT THING YOU CAN DO!
3. Bolus. A bolus is used to (a) cover the carbohydrate in meals and to (b) lower high blood sugars.
a) Your carb bolus will match the amount of insulin required to the amount of carbohydrate eaten.
b) High blood sugar boluses are used to correct your BG reading and return you to your targeted zone.
4. A fasting basal test is a means of checking that your background insulin requirements are correct.
A fasting basal should be done from time to time to insure that your body's background insulin needs are being met. With our daughter, that is fairly often as she is a hormone with feet, and is growing at an amazing rate. Her basal needs change often.
5. You can set and change basal rates by fasting. These fasting periods can be done over hours/days, and require checking bg readings while not eating. If your blood glucose is acceptable at the beginning of a fasting basal check, and rises steadily in the hours following, it is a good indication that your basal rate is too low for that period. If, on the other hand, your blood glucose readings drop after you begin your check, it is a good indication that your basal rates are too high.
When pumping, it is important to remember that it is a very individual process and requires attention and record keeping.
6. Setting and checking carbohydrate bolus ratios for boluses will be much more accurate after setting proper basal rates. SETTING PROPER BASAL RATES IS THE MOST IMPORTANT THING YOU CAN DO!
Once the basal rate is set, you must determine your body's requirements of insulin to carbohydrates. This will be your carbohydrate bolus ratio and is based on "one unit insulin to _X__ grams of carbohydrate" (Insulin:Carbs). There are various tables in the Pumping Insulin book and on the Insulin Pumpers Website which aid you in determining bolus ratios. If you set your bolus ratios properly, you can determine the amount of carbohydrate in your food and use your ratio to determine the amount of insulin required for your meal. Blood sugars will then stay in an acceptable range.
7. You should be suspicious of your basal rates if your blood sugars rise/drop steadily in the run of a day and you can't relate it to food, activity, illness, hormones etc.
8. Your insulin:carb bolus ratio may need change if you find that blood sugars rise/drop after eating but remain stable otherwise.
9. Carbohydrate counting is the most accurate means of determing insulin requirements for your meals. You are able to determine the grams of carbohydrate in a meal/beverage which allows you to use your insulin:carb ratio and correctly bolus to cover it.
10. You would determine the amount of bolus required for a high blood glucose reading by determining the amount of insulin your body requires to drop 'x' amount from 'y' blood glucose reading. The ratio you might use to determine this will likely change depending on the level of the high blood glucose. Our daughter requires a higher ratio of insulin:glucose to drop her from a reading of 16.0 mmol (288 mg/dl) to a reading of 5.0mmol (90 mg/dl) then she would to drop her from a reading of 8.0mmol(144 mg/dl) to a reading of 5.0mmol (90 mg/dl).
11. Most people, us included, tended to overtreat our daughter when we first started pumping. The amount we would have given her as a means of preventing a middle of the night low while on injections would send her blood sugars through the roof while on the pump. One thing to keep in mind when treating a low (and a high too for that matter), is how much insulin is still in the system from a previous bolus. That would lead us to the 'Unused Insulin Rule'.
12. The unused insulin rule and knowing how far your blood sugar will drop with one unit of insulin (we use Humalog)helps you determine how much insulin is still active from a previous bolus. This will help in determining the amount of insulin requqired to treat a high BG, or the amount of carbs required to treat a low.
13. Know the actions of your pump inside and out. It will give you more confidence and enable you to better handle situations. It can be pretty frustrating (and embarrasing too), to have a pump alarm sounding and not know why or how to shut it off! Know your pump's features.
14. There are many different types of infusion sets available to you. If you are unsuccessful with an infusion set, and have tried to correct your problems with no success, there are others you can try!
15. We put infusion sets in the back, tummy, and upper butt. I know of people who use their breasts, arms, and legs. Some sites are more successful then others and the only to find out is to try!
16. Frequents BG tests are a must if you are to pump successfully and safely. My daughter checks upon waking, prior to each time she consumes food, prior to bed, and we check her through the night if she has had to do corrective boluses or treat a low. Blood sugar can rise quite quickly without the benefit of long lasting insulin in the pump. While doing a fasting basal check, they are done even more frequently to help determine her body's insulin needs.
17. Keeping a good record of basal rates, boluses, blood sugars, and other related activities is particularly important when you start pumping. It will help you to spot patterns and make corrections in boluses/basal rates.
This quiz and its supporting information are a means of my sharing information with you. In order to fully educate yourself, it is important to read as much literature about pumping as possible. Although I have given you the 'answers' to the questions, I have not elaborated much on them. That is for you to do! Read...ask questions...and read some more!!! You can never know enough, and every day will be a learning process it its own way.
Remember, I AM NOT A MEDICAL PROFESSIONAL!! Confirm any changes you might want to make with your diabetes team.
Check the link to the Insulin Pumpers website on my contact page. You will be glad you did!